Healthcare Provider Details

I. General information

NPI: 1538374798
Provider Name (Legal Business Name): DEBORAH ANN MARRINGTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH GUNNING CRNP

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 NORTHBROOK BLVD
NORTH CHARLESTON SC
29406-9252
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberSP007302
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP007302
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number25371
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: